Rao Anirudh, Zaaqoq Akram M, Kang In Guk, Vaughan Erin M, Flores Jose, Avila-Quintero Victor J, Alnababteh Muhtadi H, Kelemen Anne M, Groninger Hunter
Department of Medicine, 12230Georgetown University School of Medicine, Washington, DC, USA.
Department of Medicine, Section of Palliative Care, 8405MedStar Washington Hospital Center, Washington, DC, USA.
Am J Hosp Palliat Care. 2021 Jul;38(7):854-860. doi: 10.1177/10499091211001009. Epub 2021 Mar 9.
Critically ill patients with COVID-19 infection on extracorporeal membrane oxygenation (ECMO) face high morbidity and mortality. Palliative care consultation may benefit these patients and their families. Prior to the pandemic, our institution implemented a policy of automatic palliative care consultation for all patients on ECMO due to the high mortality, medical complexity, and psychosocial distress associated with these cases.
The main objective was to describe the role of the palliative care team for patients on ECMO for COVID-19 infection. The secondary objective was to describe the clinical outcomes for this cohort.
Case series.
SETTINGS/SUBJECTS: All patients age 18 or older infected by the novel coronavirus who required cannulation on ECMO from March through July of 2020, at an urban, academic medical center in the United States. Inter-disciplinary palliative care consultation occurred for all patients.
Twenty-three patients (median age 43 years [range 28-64], mean body mass index 34.9 kg/m2 [SD 9.2], 65% Hispanic ethnicity) were cannulated on ECMO. Eleven patients died during the hospitalization (48%). Patients older than 50 years of age demonstrated a trend toward increased odds of death compared to those younger than 50 years of age (OR 9.1, = 0.07). Patients received an average of 6.8 (SD 3.7) palliative clinical encounters across all disciplines. The actions provided by the palliative care team included psychosocial support and counseling, determination of surrogate decision maker (for 100% of patients), pain management (83%), and non-pain symptom management (83%).
Here, we present one of the first studies describing the patient characteristics, outcomes, and palliative care actions for critically ill patients with COVID-19 on ECMO. Almost half of the patients in this cohort died during their hospitalization. Given the high morbidity and mortality of this condition, we recommend involvement of palliative care for patients/families with COVID-19 infection who are on ECMO. The impact of palliative care on patient and family outcomes, such as symptom control, satisfaction with communication, rates of anxiety, and grief experience merits further investigation.
接受体外膜肺氧合（ECMO）治疗的新型冠状病毒肺炎（COVID-19）重症患者面临着较高的发病率和死亡率。姑息治疗会诊可能使这些患者及其家属受益。在疫情大流行之前，由于与这些病例相关的高死亡率、医疗复杂性和心理社会困扰，我们机构实施了一项针对所有接受ECMO治疗患者的自动姑息治疗会诊政策。
主要目的是描述姑息治疗团队在COVID-19感染接受ECMO治疗患者中的作用。次要目的是描述该队列的临床结局。
病例系列。
地点/研究对象：2020年3月至7月期间，在美国一家城市学术医疗中心，所有18岁及以上感染新型冠状病毒且需要在ECMO上插管的患者。所有患者均接受了跨学科姑息治疗会诊。
23例患者（中位年龄43岁[范围28 - 64岁]，平均体重指数34.9 kg/m²[标准差9.2]，65%为西班牙裔）接受了ECMO插管。11例患者在住院期间死亡（48%）。与50岁以下患者相比，50岁及以上患者的死亡几率有增加趋势（比值比9.1，P = 0.07）。所有学科的患者平均接受了6.8次（标准差3.7）姑息治疗临床会诊。姑息治疗团队提供的行动包括心理社会支持与咨询、确定替代决策者（100%的患者）、疼痛管理（83%）和非疼痛症状管理（83%）。
在此，我们展示了首批描述COVID-19重症患者接受ECMO治疗的患者特征、结局及姑息治疗行动的研究之一。该队列中近一半患者在住院期间死亡。鉴于这种情况的高发病率和死亡率，我们建议对接受ECMO治疗的COVID-19感染患者/家属提供姑息治疗。姑息治疗对患者和家属结局的影响，如症状控制、沟通满意度、焦虑率和悲伤体验，值得进一步研究。
